KLE UNIVERSITY -KLEU AIET - 2012 APPLICATION FORM

Applications submitted more than once will be rejected Please fill the application and click on submit button, then you will get a preview screen, in that preview screen at the bottom you will get a button "Print this Form" Please click this button, you will get the print out, in that print out you will get space for sticking Photograph and Thumb impression. Note: Make sure your computer is connected to printer
Course Intending to apply	M.Pharm M.P.T M.D Ayurveda M.Sc.N ^*
Candidate Details
1. Candidate's Name :(As given in class SSLC/10th Certificate)	^*
2. Father's/Mother's Name :	^*
3. Gender :	Male Female ^*
4. Date Of Birth :	^* [eg: DD/MM/YYYY]
5. Address for Communication:	^*


CITY
PIN :	^*
District
STATE
6. E-Mail :	^*
7. Telephones :
STD Code	^*
Telephone	^*
Mobile
8. Choice Of Centre :	^*
9. Category :	General BRD KTC BRD & KTC ^*
12. Details of Demand Draft :
D. D. No.	^*
Amount in Rs	^*
Date Of Issue	^* [eg: DD/MM/YYYY]
Name of Drawee Bank	^*
13. Details of Education :
Qualifying Exam	B.Pharm B.P.T B.A.M.S B.Sc.N Post B.Sc.N *
Name of University	^*
Name of College	^*
Month/Year of Passing :	/ ^*
Month/Year of Internship completion/completing : Should complete internship by 30/04/2012	/ Please leave blank if Not Applicable
14. Please enter the Exact Percentage of Marks scored in Final Year and Agregate of UG Course
	Pecentage of Marks If blank enter 0 (Do Not Enter % Symbol)
Final Year (Please enter '0' if Not Applicable)	%
Aggregate Year (Please enter '0' if Not Applicable)	%
15. Declaration - I I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled. If admitted to any of the college of KLE University, Belgaum I shall abide by its Rules & Regulations. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions. I am aware that, any legal matters arising out of the total admission process of any Course through KLE UAIET - 2012 will be in the courts of Belgaum. I will not indulge in any kind of ragging activities.